Provider Demographics
NPI:1932191335
Name:EMMICK, CYNTHIA JO (ARNP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JO
Last Name:EMMICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8070 U.S. HWY. 60 WEST
Mailing Address - Street 2:
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351-0078
Mailing Address - Country:US
Mailing Address - Phone:270-295-3400
Mailing Address - Fax:270-295-3401
Practice Address - Street 1:8070 U.S. HWY. 60 WEST
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-0078
Practice Address - Country:US
Practice Address - Phone:270-295-3400
Practice Address - Fax:270-295-3401
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002821363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010691Medicaid
KYS81683Medicare UPIN
KY78010691Medicaid